Foreword.
The validity of the thermal mud-bath therapy in the prevention and treatment of several degenerative pathologies of the musculoskeletal system ahs already been widely demonstrated by several scientific studies and is therefore universally accepted and certified by the Italian Ministry of Health. However, the assessment of all collateral effects that a thermal mud treatment may cause in the human body is also quite interesting.
The study of such adverse effects make it possible for us to develop our treatment protocols further and offer our customers better service. Below is a summary of the research activities carried out at the Ermitage thermal spa by the staff of the University of Milan, led by Professor Veicsteinas in August 2007. As detailed below, in the first year of this three-year study the mud therapy treatment evidenced interesting interactions with the cardiovascular and metabolic systems.

Modalities of the thermal treatment.
The total duration of the treatment was 2 cycles. Practically speaking, in the morning the subjects, on an empty stomach or after a light breakfast, were subject to a medical examination, a 15-minute mud treatment, followed by a quick shower with thermal water and the immediate immersion in a thermal bath at a temperature of 37�C for 10 minutes. After 15 minutes� rest (relax), lying on their backs or sitting down, the subjects underwent a reaction massage for 15 minutes and then to the final assessment in the medical surgery.

Measured variable.
During the study, the following variables were measured (each is accompanied by a synthetic description). Energy consumption, that is to say, the calories burned in a given period of time, was measured with the open circuit method. The subject was asked to breathe in air through a mouthpiece and a valve array and to breathe out through a tube that brought air to a balloon, where the expired air was collected and later analysed. From the concentrations of oxygen and carbon dioxide in the exhaled air and from the amount of air breathed out in a minute, it is possible to calculate the amount of oxygen burned per minute and thus the energy consumption.
Heart rate, that is, the number of heartbeats in a minute, was continuously monitored with an electronic device equipped with a recorder that makes it possible for the experimenter to view the heart rate both immediately and later on, thanks to a computer screen. Maximum and minimum arterial blood pressure was measured with the standard clinical method (Riva Rocci method). Body temperature was measured in the mouth, inserting a thermometer under the tongue of the patients, who then kept it in their closed mouths for 8 minutes.
Body weight was measured with the subjects wearing a bathing costume, on a portable balance. Blood analysis included the following parameters: red cell, white cell, platelets concentration, as well as the following chemical parameters: azotemia, glycaemia, total blood cholesterol and HDL, electrolytes (sodium, potassium, chlorine). The concentration of glycated haemoglobin was also determined, to check for type 2 diabetes, which the subjects themselves might be unaware of, as is often the case after 55 years of age, as well as the homocysteine concentration, as it is an important factor for the prevention of cardiovascular pathologies. Both these latter parameters were normal in all subjects. The blood samples were usually taken in the morning, before the patients broke their fast and before starting the thermal treatment (time 0), then after one cycle (time 1, after one week of treatment) and after two cycles of treatment (time 2, after two weeks of treatment).

Results and Comments.
Acute variations (time 0). One of the project�s goals was to analyse the variation of some cardiovascular parameters after the first mud therapy and bath therapy treatment, assessing the relevant weight and body temperature changes. As expected, the laying down position and the covering of most of the patient�s body with thermal mud at a temperature of 40-43�C led to significant increases in body temperature, with the consequent adjustments in terms of heart rate and circulation. The body temperature, assessed at an average 36.6-36.8�C in all subject prior to the mud treatment, increased by 0.3 to 0.6�C (up to 37.2�C). This increase leads to a peripheral vasodilation with an increase in the blood flow to the various organs, in particular to the muscles, and a consequent decrease of blood pressure, both maximum and minimum, (by 5-10 mmHg) and an increase in the heart rate (on average up to 10 beats a minute more) to compensate for the drop in pressure. The blood pressure values measured after 15 minutes� mud treatment fall further down, even though not greatly so, during the subsequent immersion in the thermal water pool. After the thermal bath, the subject stands drying him/herself and then goes to the relaxing area. In the brief span of time in which the subjects stand, for a couple of dozens of seconds there is a further reduction of blood pressure, by some mmHg, followed by a rapid increase of the same, by 5-15 mmHg, due to the well known compensatory effect related to the body position. For the same reason, the heart rate temporarily increases further, by 6-15 beats per minute, sometimes 15 beats per minute, and then goes down again. These blood pressure and heart rate oscillations are perfectly consistent with the physiological changes the subject undergoes also during the normal daily activities, and is in no way a cause of concern.
At the end of the daily thermal treatment, that is to say, after the relaxation time and the reaction massage, heart rate, blood pressure and body temperature all go back to values that are similar to those measured before the treatment.
During the mud therapy, pulmonary ventilation and energy consumption (on average, around 10 l of air breathed in a minute, with an oxygen consumption of 250 ml per minute) increase mildly, and they go back to the pre-therapy values in about half an hour. Weight loss after treatment is quite evident in all subjects, and varies between 400 and 600 grams, due to intense sweating. In the following hour, body weight increases by some hundreds of grams, due to the water which is often drunk after the treatment.

Summary.
This study was conducted at Abano Terme�s Ermitage Medical Spa and is included in the wider context of a research project launched in association with the Physical Exercise, Health and Sports Activities Institute of the University of Milan. In this first phase, where the subjects where middle-aged or elderly and healthy, the goal was that of analysing the cardiovascular and metabolic adaptations, as well as the variations in certain blood parameters, following the thermal treatment administered by the Spa. The daily treatments (single daily treatment) include mud therapy (15 minutes), bath therapy (10 minutes) relax (15 minutes) and reaction massage (15 minutes). With the exception of blood parameters, the assessments were made during the first thermal treatment session, and after one and two weeks, so as to determine the acute effects on the body and the effects after adaptation has taken place, after one and two treatment cycles. No diet was required of the subjects, in terms of either quality or quantity of food intake.
The comparison between the values before and after mud-bath therapy shows that: body weight decreased, on average, by about 500 grams at time 0, and by about 300-400 g after 1 and 2 treatment cycles; maximum and minimum arterial blood pressure both decreased by 10-15 mmHg on day one and to a slightly lesser extent further on in the treatment; heart rate increases by 5-15 beats per minute in the beginning, and to a slightly lesser extent after one and two weeks. Energy consumption due to the treatment increased slightly and erratically, and such increased consumption remained independently of the treatment period. The examination of the various blood parameters showed a modest reduction of cholesterol, a considerable reduction of triglycerides, showing that, notwithstanding the moderate increase in body weight, there seems to be a slight improvement of the lipid parameters.
To conclude, it can be said that mud therapy and bath therapy, both after a single session and following one and two weeks of treatment, cause mild alterations of the cardiovascular system, that are perfectly tolerated by the patient, abundant perspiration with a reduction in body weight after the individual treatment and a slight improvement of the blood lipid parameters. Body weight shows slight, non significant alterations, also due to the free diet. The assessment of the effectiveness or the treatment on bone, joint and muscle pathologies is outside the scope of this investigation.